INTERPRETATION:We found no prophylaxis to be non-inferior and cost-saving in preventing contrast-induced nephropathy compared with intravenous hydration according to current clinical practice guidelines.

2. LEVO-CTS TRIAL

左西孟旦治疗心外手术的左室功能障碍(阴性结论)

Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.

N Engl J Med. 2017 May 25;376(21):2032-2042.

doi: 10.1056/NEJMoa1616218.

PMID: 28316276

CONCLUSIONS:Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass.

CONCLUSIONS AND RELEVANCE:Among patients in the ICU requiring intubation, video laryngoscopy compared with direct laryngoscopy did not improve first-pass orotracheal intubation rates and was associated with higher rates of severe life-threatening complications. Further studies are needed to assess the comparative effectiveness of these 2 strategies in different clinical settings and among operators with diverse skill levels.

4. CHEETAH TRIAL

心外术后左心孟旦对血流动力学的支持(阴性结论)

Levosimendan for Hemodynamic Support after Cardiac Surgery.

N Engl J Med. 2017 May 25;376(21):2021-2031.

doi: 10.1056/NEJMoa1616325.

PMID: 28320259

CONCLUSIONS:In patients who required perioperative hemodynamic support after cardiac surgery, low-dose levosimendan in addition to standard care did not result in lower 30-day mortality than placebo.

5. DESIRE TRIAL

右美托咪定对脓毒症机械通气患者病死率及停机日的作用(阴性结论)

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial.

JAMA. 2017 Apr 4;317(13):1321-1328.

doi: 10.1001/jama.2017.2088.

PMID: 28322414

CONCLUSIONS AND RELEVANCE:Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further.

.....The main analyses will be on an 'intention to treat' basis, irrespective of whether the allocated treatment was received or not. Subgroup analyses for the primary outcome will be based on type of delivery; administration or not of prophylactic uterotonics; and on whether the clinical decision to consider trial entry was based primarily on estimated blood loss alone or on haemodynamic instability. A study with 15,000 women will have over 90% power to detect a 25% reduction from 4% to 3% in the primary endpoint of mortality or hysterectomy.

7. American Heart Association’s Get With The Guidelines Resuscitation Investigators

CONCLUSIONS AND RELEVANCE:Among adult patients with in-hospital cardiac arrest, initiation of tracheal intubation within any given minute during the first 15 minutes of resuscitation, compared with no intubation during that minute, was associated with decreased survival to hospital discharge. lthough the study design does not eliminate the potential for confounding by indication, these findings do not support early tracheal intubation for adult in-hospital cardiac arrest.

CONCLUSIONS:We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.

12. Detsky Trial

ICU入院6个月后医护对生存及机能预测的准确性(无)

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission

JAMA. 2017 Jun 6;317(21):2187-2195.

doi: 10.1001/jama.2017.4078.

PMID: 28528347

CONCLUSIONS AND RELEVANCE:ICU physicians' and nurses' discriminative accuracy in predicting 6-month outcomes of critically ill patients varied depending on the outcome being predicted and confidence of the predictors. Further research is needed to better understand how clinicians derive prognostic estimates of long-term outcomes.

13. REVIVE TRAIL

重症出院患者身体锻炼项目对机能的影响(阴性结论)

Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness

Thorax 2017; 72:600-609.

doi:10.1136/thoraxjnl-2016-209576

PMID: 27852953

CONCLUSIONS:There was no statistically significant difference in the primary outcome measure of self-reported physical function following this 6-week exercise programme. Secondary outcome results will help inform future studies.

14. PRECISE TRIAL

普瑞巴林治疗慢性坐骨神经痛(阴性结论，但为什么会被Bottom Line收入?)

Trial of Pregabalin for Acute and Chronic Sciatica

NEMJ 2017; 376:1111-1121.

doi:10.1056/NEJMoa1614292

PMID: 28328324

CONCLUSIONS:Treatment with pregabalin did not significantly reduce the intensity of leg pain associated with sciatica and did not significantly improve other outcomes, as compared with placebo, over the course of 8 weeks. The incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.

15. Kentish-Barnes. Trial

哀悼信对ICU死亡患者家属悲伤症状的效果(阴性结论)

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

Intensive Care Medicine 2017;

DOI 10.1007/s00134-016-4669-9

PMID: 28197680

CONCLUSIONS:In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms.

CONCLUSION:IVC collapsibility, as measured by POCUS, performs well in distinguishing fluid responders from non-responders, and may be used to guide IVF resuscitation among spontaneously breathing critically-ill patients.

17. SPARK TRAIL

小剂量呋塞米对重症患者早期AKI的疗效(先导性研究，阴性结论)

The effect of low-dose furosemide in critically ill patients with early acute kidney injury

J Crit Care. 2017 Jul 12;42:138-146.

doi: 10.1016/j.jcrc.2017.07.030.

PMID: 28732314

CONCLUSIONS:In this pilot trial, furosemide did not reduce the rate of worsening AKI, improve recovery or reduce RRT; however, was associated with greater electrolyte abnormalities.